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What is Tularaemia Disease?

Tularaemia (Tularemia) is an infectious disease. Humans can become infected following a bite from an infected tick or animal contact. The bacteria enters the body through an area of broken skin however, it can also be breathed in through the nose or mouth.

The symptoms include a high fever, generalised aching and swollen glands. The symptoms of Tularaemia can last over a period of a few weeks although it is not possible to catch the disease from other infected humans.

Who is at risk of the disease?

When visiting areas where the disease is endemic (that is: the infection is present in low levels) there is a risk. There have been recent outbreaks in all states in the USA, with the exception of Hawaii, and Netherlands. Hunters and those trecking through land where infection exists in animals and ticks are also at risk.

How Tularaemia be Prevented – also know as Tularemia?

Currently there is no vaccine available in the UK to prevent tularaemia. Travellers should be careful to ensure their surroundings are kept clean, so as not to encourage rats and other potential carriers. Any water should be boiled if used for personal consumption or food preparation. Any food should be protected from animals and cooked thoroughly. Dead animals should not be handled.

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional. Please discuss your travel health requirements with your regular family doctor or practice nurse.

What is Zika Virus?

Zika Virus has been declared a “Public Health Emergency of International concern” (WHO). It is a disease spread by mosquitos. This is not a new disease. The first human case was recognised in 1952. It is usually a mild illness which can occur up to seven days after a bite from an infected mosquito. The illness usually lasts up to a week. Symptoms include fever, rash, conjunctivitis, joint pain, headache.

Cases of Zika virus have recently been reported in Africa, Pacific Islands, Caribbean, Brazil and Southeast Asia. In recent years there has been a rapid increase in cases of the disease. Due to the nature of the disease it continues to spread globally – therefore it is best to check with your doctor or travel clinic for latest updates especially if you are a pregnant traveller.

Who is at risk of Zika Virus?

Any traveller to areas of the world where the disease exists is at risk. Due to the mild nature of the illness a traveller might not even realise they have had the disease.

Experts believe that the biggest risk of this disease is for the unborn child. There is growing evidence that Zika virus can cause birth defects.

Pregnancy and Zika Virus

Women travelling to areas where they will be at risk of Zika virus are advised:

In Pregnancy – postpone non-essential travel until after the pregnancy

How can I prevent Zika Virus?

There is currently no vaccine to prevent Zika virus, although trials are underway. The best method of prevention is bite prevention. It is important to remember that the Ades mosquito bites during the day.

Evidence also suggests the disease can be passed sexually. In order to prevent transmission:

When a partner is pregnant a condom should be used during travel and for 28 days on return

If a partner is planning or could become pregnant condom use is recommended

A male partner with symptoms of the disease following travel is recommended to use a condom for 6 months

Countries where the virus is endemic will be the same countries that other mosquito borne disease can be spread such as Dengue and Chikungunya.

The following pictorial diagram shows the lifecycle of the mosquito responsible for the spread of malaria. This diagram has been provided and reproduced with permission from GlaxoSmithKline.

Pictorial Diagram showing how Malaria spreads

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional. Please discuss your travel health requirements with your regular family doctor or practice nurse.

In most cases the virus causes mild flu like symptoms 3-14 days after the bite from an infected mosquito. Other symptoms might include eye pain, vomiting and a rash on the skin. These symptoms usually last 3-6 days.

Only 1 in 150 infected persons can go on to develop a more severe form of the disease, with increased age (over 50) being an indicator for higher risk. Severe symptoms include fever, weakness, vomiting and a change in mental behaviour. These symptoms can eventually lead to death.

Who is at risk of West Nile Virus?

Up until 1999 this disease was mainly found in Africa, Egypt, South-east Asia and the Southern parts of France. The first recorded cases in the Western Hemisphere were reported in New York in 1999 and since 2000 many cases have been reported throughout the United States and Canada. Any person travelling to these areas is at risk of the disease.

Risk is seasonal in most places and will therefore vary at different times of the year – however those travelling to the Southern States of the United States should be aware that the risk remains all year. The CDC website can provide up to date information on currently infected areas.

What can I do to prevent West Nile Virus?

There is no vaccine to prevent WNV in those travelling to high-risk areas — prevention of bites from mosquitoes is the best line of protection. Most of the mosquitoes bite from dusk to dawn and a good repellent should be used during this time, however in some areas day biters have been found so use repellent accordingly.

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional. Please discuss your travel health requirements with your regular family doctor or practice nurse.

What is Yellow Fever?

Yellow Fever is a virus, which is spread via the bite of an infected mosquito. The disease exisits in tropical areas of Africa and South America. While the disease is not found in Asia – the potential is there for spread due to the presence of the Ades mosquito, which is responsible for its spread.

Yellow Fever is recognised in two different forms – urban and jungle. Urban Yellow Fever occurs in the cities and is spread from mosquito to human to mosquito. In the jungle form Yellow Fever is spread from mosquitoes to monkeys and also to humans.

The disease presents itself after an incubation period of about 3-6 days with flu like symptoms, with death occurring in around 5% of those who become infected. There is no treatment for Yellow Fever, and so relief of symptoms is the primary course of action.

Who is at risk of Yellow Fever?

Any traveller to areas where Yellow Fever is endemic (that is: the infection is present in low levels) is at risk. This includes areas of Africa and South America.

How can I prevent Yellow Fever?

Travellers should obtain the necessary vaccination and a certificate of vaccination when travelling to endemic areas of the world. This certificate is the ONLY internationally regulated certificate. The WHO recommends it for all travellers to endemic areas, as well as for those coming from an endemic area to an area of potential transmission. The purpose of the certificate is not only to protect the traveller but to also protect those in areas of the world where infection is possible due to the presence of the Ades mosquito. It is essential to ensure that the traveller plans ahead due to the shortages of vaccine at this present time.

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional. Please discuss your travel health requirements with your regular family doctor or practice nurse.

What is Typhoid?

Typhoid is a bacterial infection of the digestive tract, caused by gram-negative bacillus Salmonella typhi. It is spread by faecal-oral route via contaminated food and water from an infected human carrier. Typhoid is often transmitted by person-to-person contact, especially via food handlers. Incubation is 1-3 weeks and is rare under 2 years of age.

Symptoms usually appear over the course of a month, with headaches and lethargy progressing to myalgia and abdominal discomfort. Some patients show a ‘rose spot’ rash after the first week of infection. Constipation can occur followed later by bloody diarrhoea with rigors. Patients remain infective for 6 weeks to 3 months after infection.

Who is at risk of Typhoid?

Typhoid is present in South America, Africa and areas of Asia, with undeveloped areas being of a higher risk. Cases can potentially occur throughout the world due to the mode of transmission and speed of travel. Natural disaster and imported cases allow for sporadic cases in parts of the world that would be considered low risk areas.

How can I prevent Typhoid?

Vaccination (injectable or oral) for risk areas and occupational risk should be considered. Vaccination against both Hepatitis A and Typhoid combined is also available for travellers, as the two diseases have a similar epidemiology and share some transmission routes. As vaccination does not offer 100% protection, avoiding potentially contaminated food and drink is essential.

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional. Please discuss your travel health requirements with your regular family doctor or practice nurse.

The BCG vaccine contains a weak form of the disease

The BCG Vaccine (Bacillus Calmette-Guérin Vaccine) protects an individual against Tuberculosis. Since vaccination began in 1953 in the UK recommendations for vaccination have changed over time. Routine school vaccination for teenagers stopped in 2005. The UK vaccination programme is now “risk based”.

Currently in the UK vaccination is only given on the NHS to babies, children and adults under the age of 35 living in high risk areas of the country (including London).

The vaccine contains a weak form of the disease

The vaccine is a live vaccine

The vaccine does not contain Thiomersal

There are no preservatives in the vaccine

For those travelling overseas the BCG vaccine is only given, if required, following a full risk assessment and tuberculin sensitivity test. Travellers under the age of 16 years living and working in a high risk area for more than three months would be considered for vaccination.

If you are travelling overseas it is important to have a full risk assessment to determine if the BCG vaccine is required. A private travel clinic will be able to determine your risk and provide advice to help you determine if you need to have the vaccine.

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional. Please discuss your travel health requirements with your regular family doctor or practice nurse.

Tuberculosis is spread from person to person via droplets in the air from coughing or sneezing. On rare occasions, it is spread via contaminated milk in the tropics.

Once an individual is infected they can remain without symptoms or go on to experience weight loss and general ill health. Tuberculosis most commonly affects the lungs and is accompanied by persistent coughing, blood stained sputum (phlegm), chest pain and fever.

Who is at risk of Tuberculosis?

Tuberculosis is found all over the world with China and India having the highest number of cases and Africa having the most deaths. In the UK, there has been a 25% increase in cases in the last ten years mainly among those from Asian backgrounds.

TB can only be caught from someone who already has the disease.

In the UK, routine vaccination of all school children is no longer practiced (DOH July 2005). A new vaccination programme now targets those children and adults at highest risk to the disease.

For those travelling to high-risk areas, such as Africa, Southeast Asia and parts of South America, proof of immunity is recommended.

How can I prevent Tuberculosis?

Partial protection is gained through BCG vaccination. The vaccination is only given at the presentation of a negative mantoux or heaf test. Only newborn babies are vaccinated without the test.

It is essential for all travellers going overseas to have a test and the subsequent vaccination if required. It is possible that immunity after vaccination is not lifelong and therefore all persons moving abroad to work in risk areas should consider testing, especially if the vaccination scar is not present. For advice regarding BCG, you should make an appointment with your family doctor or Travel clinic nurse.

For those with TB, treatment involves a variety of antibiotics taken over a period of months. The treatment will cure the disease ONLY if the treatment is continued until the end of the course. Because many people feel better, they stop taking the medication and this results in a recurrence of the disease.

NON-UK VISITORS TO THIS SITE:

Please note that the recommendations in other countries may differ from those in the UK and local advice should be sought.

Resources for TB

NHS Immunisation Information Service has produced multi-lingual fact sheets about TB and other vaccine preventable diseases

Amazon has a collection of books covering history and medical treatment of TB including Timebomb: The Global Epidemic of Multi-drug-resistant Tuberculosis (Paperback) £6.95

Health Protection Agency provides excellent information and reports on Tuberculosis with latest health reports and epidemiological data from the UK and abroad.

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional. Please discuss your travel health requirements with your regular family doctor or practice nurse.

What is Tick Borne Encephalitis?

Tick Borne Encephalitis is a viral disease spread via the bite of an infected Ixodes tick. It can also be transmitted via unpasturised milk from infected goats or cows. Ticks bite humans when they walk through undergrowth or grasses where contact is made. Peak biting times are during the warmer months of August, or following a warm humid summer in September and October. After an incubation period of 2-28 days, symptoms begin with a fever and can progress at varying degrees. Death rates are highest in the elderly.

Who is at risk of Tick Borne Encephalitis?

Tick Borne Encephalitis is a risk for travellers going to endemic areas; that is: areas where infection exists at low rates. It is most prevalent in Europe and Asia in long grass and undergrowth, at a tick infection rate of 5%. A variation of Tick Borne Encephalitis occurs in Russia and China.

How can I prevent Tick Borne Encephalitis?

While a vaccination is available for those at high risk, travellers should try to avoid areas where the disease is prevalent. If it is essential to go walking in long grass or undergrowth, suitable clothing should cover arms and legs, with trousers tucked into socks for protection. DEET can also be used as a repellent. Those trekking can impregnate cloth with permethrin to use as a ground sheet to sit on in infected areas.

If a tick gets onto the skin, it should be removed using the correct technique of pulling it straight from the skin using tweezers or a similar instrument, not twisting.

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional. Please discuss your travel health requirements with your regular family doctor or practice nurse.

After an incubation period of around 12 days the disease affects the nervous system, causing muscle spasms and rigidity. This can eventually lead to respiratory failure and death.

Who is at risk of Tetanus?

Tetanus spores are found all over the world including the United Kingdom.

How can I prevent Tetanus?

The best method of protection is vaccination. In the UK tetanus vaccination is part of the routine immunisation programme and is given in a combined vaccine with diphtheria as a primary dose and reinforced for the purpose of travel. For those remaining in the UK, current UK guidelines state that a total of five doses of the vaccine are considered to give lifelong immunity — the exception is in the case of a tetanus prone wound when a booster is given as required.

Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional. Please discuss your travel health requirements with your regular family doctor or practice nurse.